Improving Communication Among Surgeons

Michigan State University researcher Cheryl Anderson has found a better way for veteran surgeons to provide feedback to their aspiring surgeon counterparts during their residencies.

In a new study, Anderson, director of quality improvement and surgical education in the College of Human Medicine, shows that formative feedback and the communication between teacher and student improved under a more-structured process using proven educational models. Formative feedback is input that helps students identify strengths and weaknesses, as well as focus on areas that need work.

According to earlier surveys, two-thirds of veteran surgeons training young residents said they regularly give feedback. Yet fewer than 20 percent of the surgeons-in-training said they received any feedback.

“The residents were saying feedback was, at best, haphazard and, at worst, nonexistent,” said Ashraf Mansour, chair of the Department of Surgery. “There was really no specific feedback given on what they did well, what they did poorly and how they could improve.”

Implementation of a structured model, along with continuous quality improvement efforts, resulted in an increase in the frequency and timeliness of the feedback the surgeons gave their residents.

Anderson and her team analyzed more than 5,000 entries from approximately 110 surgeons and 175 residents at various hospitals and health care facilities including Thomas Jefferson, Emory, Santa Barbara, McLaren Flint, Henry Ford Allegiance Health, MSU/Sparrow Obstetrics and Gynecology and Reproductive Biology, McLaren Greater Lansing and Carle Health.

As a result, Anderson developed a large repository of learning objectives based on these entries believed to be the only known database of resident-centered learning needs. The briefing and debriefing model now has been used across these locations an average of 90 percent or more for more than four years.

Since the study, the number of faculty assessments received for each resident has more than doubled and the timeliness of learner assessments was reduced from 16 days to less than one. Resident participation in the process increased by 135 percent.

Anderson has also designed a faculty surgeon and resident portal where all input data can be viewed in real time by participants. Many surgeons often postponed filling out paper assessments until the end of a rotation due to lack of time. By then, many details of the cases had been forgotten, leaving little opportunity for learners to improve.

“Many residents had no idea if they were progressing because they weren’t getting timely or formative feedback,” Anderson said. “Now feedback is regular and readily available.”

Currently, Anderson is working with MSU Information Technologies to develop a computer application, which can be offered to surgical training programs across the country.

“We think we can influence surgical and medical education in more than nine programs,” she said. “Don’t get me wrong. We’ve got a lot of work to do, yet we recognized the potential impact this work may have on the future of surgical education.”

The lack of precise feedback in surgical training “has been a weakness for a long, long time,” Mansour said. “I have been on national committees where this has been a constant battle.”

Anderson said she’s optimistic the study will continue, driven by new research questions that will arise from the data collected and the work of other educators. She believes this approach may not only help “to produce competent surgeons,” but it also improves care for surgical patients.

“After all,” she said, “that’s our goal.”

Key members of Anderson’s team include Muhammad Ali, Marc Basson, Michael McLeod, Robert Osmer, Pam Haan, Alan Davis, and current MSU surgery residents and consortium site leadership.